| Project/Area Number |
23K07573
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Multi-year Fund |
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| Section | 一般 |
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| Review Section |
Basic Section 53020:Cardiology-related
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| Research Institution | Hamamatsu University School of Medicine |
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Principal Investigator |
成瀬 代士久 浜松医科大学, 医学部, 助教 (80814417)
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| Co-Investigator(Kenkyū-buntansha) |
坂本 篤志 浜松医科大学, 医学部, 助教 (80940436)
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| Project Period (FY) |
2023-04-01 – 2026-03-31
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| Project Status |
Granted (Fiscal Year 2023)
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| Budget Amount *help |
¥4,680,000 (Direct Cost: ¥3,600,000、Indirect Cost: ¥1,080,000)
Fiscal Year 2025: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000)
Fiscal Year 2024: ¥1,690,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥390,000)
Fiscal Year 2023: ¥1,820,000 (Direct Cost: ¥1,400,000、Indirect Cost: ¥420,000)
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| Keywords | 急性心筋梗塞 / 致死性不整脈 / 着用型除細動器 / 植込み型除細動器 |
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| Outline of Research at the Start |
急性心筋梗塞は心不全や致死性不整脈、心破裂等を合併する致命的な疾患であり、退院後も心筋梗塞患者の突然死リスクは高いため、植込み型除細動器 (ICD)などの適切な治療介入が必要です。日本循環器学会の不整脈非薬物治療ガイドラインでは、「電気生理学的検査での致死性不整脈の誘発」など6つの条件の組み合わせでICD植込みの推奨クラスが決定されますが、まだ他に考慮されるべき因子が存在すると考えられます。
本研究では急性心筋梗塞の多施設前向きレジストリーを利用して、急性心筋梗塞発症後亜急性期および慢性期に発生する致死性不整脈イベントに関連する新たなリスク因子を見出すことを目的としています。
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| Outline of Annual Research Achievements |
2023年3月31日現在で363例を登録した。
このうち206例登録時点の退院時までのデータについて第88回日本循環器学会学術集会で発表した（Actual status of wearable cardioverter defibrillator use in patients with acute myocardial infarction -A report from SING AMI registry-）
この発表の結果と結論は以下の通りである。
Results: Among 206 patients with AMI (ages 70.9 ± 12.8 years, male 74.8 percent), 13 (6.3%) had WCD indication. Although physicians considered WCD indication for 9 patients, misidentified indication in 7: VF occurrence within 48h after AMI onset in 2, NSVT in 2, and unknown reason in 3. Of 20 patients with WCD indication or misidentified indication, 19 patients did not receive informed consent about WCD because physicians missed indication in 11, poor general condition in 2, expected poor compliance in 2, and ICD implantation before discharge in 1, unknown reason in 4. One patient disagreed with taking WCD because of the high cost and resistance to WCD. As a result, WCD was prescribed in no patients.
Conclusions: Data from the SING AMI registry showed that using WCD after AMI was underused although WCD was indicated in 6% of patients with AMI undergoing primary PCI. Rate of misidentification for WCD indication was not rare (8.7%), even at facilities with capable of WCD.
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| Current Status of Research Progress |
Current Status of Research Progress
2: Research has progressed on the whole more than it was originally planned.
Reason
おおむね予想通りのペースで症例登録が出来ている
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| Strategy for Future Research Activity |
参加施設の増加を検討している。症例登録を進め、それぞれの症例で心筋梗塞発症後2年間のFollow upを行う。そのFollow upデータも含めて論文化を行う予定である。
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